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Cochlear implant
|Cochlear implant
Cochlear implant
A cochlear implant (CI) is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing.
Cochlear implants may help provide hearing in patients who are deaf because of damage to sensory hair cells in their cochleas. In those patients, the implants often can enable sufficient hearing for better understanding of speech. The quality of sound is different from natural hearing, with less sound information being received and processed by the brain. However, many patients are able to hear and understand speech and environmental sounds. Newer devices and processing-strategies allow recipients to hear better in noise, enjoy music, and even use their implant processors while swimming.
As of December 2012, approximately 324,000 people worldwide have received cochlear implants; in the U.S., roughly 58,000 adults and 38,000 children are recipients.[1] The vast majority are in developed countries due to the high cost of the device, surgery and post-implantation therapy. A small but growing segment of recipients have bilateral implants for hearing stereo sound (one implant in each cochlea).[2]
- 1 History
- 2 Parts of the cochlear implant
- 3 Candidates
- 4 The operation, post-implantation therapy and ongoing effects
- 5 Cost
- 6 Efficacy
- 7 Risks and disadvantages
- 8 Functionality
- 9 Scientific and technical advances
- 10 Manufacturers
- 11 Criticism and Controversy
- 12 See also
- 13 References
- 14 Further reading
- 15 External links
The first direct stimulation of an acoustic nerve with an electrode was performed in the 1950s by the French-Algerian surgeons André Djourno and Charles Eyriès. They placed wires on nerves exposed during an operation, and reported that the patient heard sounds like "a roulette wheel" and "a cricket" when a current was applied.[citation needed]
The first attempt to develop a clinical CI was in 1957 by Djourno and Eyriès. A recipient was implanted with a single channel device. Unprocessed sounds were transmitted via a pair of solenoid-like coils. The link was therefore transcutaneous; it did not require a break in the skin after implantation. This device failed after a short time and another device was implanted. After this second device failed, Eyriès refused to implant a third device. He urged Djourno to collaborate with an industry partner to build a more reliable device. Djourno refused because he believed that academia should not be tainted by commerce. Djourno found another surgeon, Roger Maspétiol, who implanted a second patient in 1958.[3] Although these recipients were unable to understand speech with the device alone, it helped with lipreading by providing the rhythm of the speech.
In 1961, Dr. William F. House, an otologist considered the inventor of the cochlear implant,[4] John Doyle (a neurosurgeon) and James Doyle (a physicist) commenced work on a single-channel device in Los Angeles. In one case a five-wire electrode was used but the same signal was applied to all contacts. House's work continued in the 1970s in collaboration with engineer Jack Urban. Their implant was also a single-channel device but, in this case, the speech was modulated onto a carrier of 16 kHz. The device, manufactured by 3M, was ultimately implanted in some thousand or so recipients and paved the way for future clinical development of multichannel CIs.[5] The House/3M unit was the first approved by the FDA for implantation in adults in 1984.
In 1964, Blair Simmons at Stanford University implanted some recipients with a six-channel device. This device used a percutaneous plug to enable the electrodes to be individually stimulated. Recipients could still not understand speech through the device but, importantly, it demonstrated that by stimulating in different areas of the cochlea, different pitch percepts could be produced.[6]
In 1970, Robin Michelson, M.D., reported preliminary results of cochlear implantation in three deaf adults implanted with gold wire electrodes. Initially he teamed with Mel Bartz, an electrical engineer working with Storz, Inc. Michelson's report to the American Academy of Otolaryngology and Ophthalmology created a tempest. Orthodox auditory theory was in confusion at the time, and it was not thought possible for direct electrical stimulation of neural tissue to convey meaningful sound to the brain. Michelson conducted some work in San Francisco, in the Coleman Laboratory at the University of California, a foundation funded by the wealthy ENT department chairman at UCSF, Francis Sooy, MD. Michelson's implantation of humans before animal physiology experiments caused consternation among physiologists, audiologists, and many otologists. An otolaryngology resident, C. Robert Pettit, heard Michelson describe the results of his cochlear implantations at a department educational meeting. He ran to the Coleman Laboratory, where Michelson spent one half-day per week away from his Redwood City private ENT practice, and told the older surgeon of his dream since college of a multi-channel electrode resembling a hairbrush. Michelson said so many stimulus points were not necessary and that his patients were hearing "in stereo" with a two-channel electrode he had designed. Michelson and Pettit teamed to build the bipolar electrodes embedded in silastic which replaced the broken gold electrodes in Michelson's three patients. The reimplantation procedures were carried out in Redwood City Community Hospital, not at UC San Francisco, as were the original implants.
Soon, the UCSF department chairman recruited Michael Merzenich, a young PhD, to carry out his research interests in neurophysiology, mapping the inferior colliculus, and to investigate the potential of cochlear implantation. Merzenich was enormously skeptical of the cochlear implant project, but agreed to test cats Michelson and Pettit had implanted. Merzenich was skilled at constructing micro-electrode needles capable of penetrating single nerve cells without rupturing the cell membranes and spilling cell contents. He agreed to monitor electrical activity in inferior colliculus cells of cats stimulated by normal sound in one ear, and electrical input from a cochlear implant in the other ear, finding both auditory stimuli similar. Merzenich had constructed an advanced electronic bank of signal generating and monitoring equipment for use in his mapping experiments and a carefully shielded soundproof booth for testing. Over the months of animal testing, Merzenich became convinced that the electrical signal from the cochlear implant was entering the brain and was "phase-locked." Understanding what humans heard with the cochlear implant was another matter.
New tests were devised for implanted patients. One was congenitally deaf and had never heard sound. Pettit employed a music professor to synthesize simple tunes and sounds in various sound envelopes, and new pitch and loudness-scaling tests were devised. When one of the reimplanted patients was tested by the team under carefully controlled laboratory conditions, in 1972, a version of "Where Have All the Flowers Gone?" played on a Moog Synthesizer was presented to the patient through the cochlear implant. The camera caught the patient humming the melody and tapping a pencil to the tempo of the tune. That sequence convinced the department chairman to support the cochlear implant project. When the film was shown to a meeting of otologists later in 1972, it convinced the scientific community that meaningful sound could be conveyed to the brain by electrical stimulation of the auditory nerve.[7][8]
Cochlear implants that operate successfully, including those produced by all three major manufacturers (Cochlear Corporation, Advanced Bionics and Med-El), incorporate the same basic design. Likewise, all cochlear implants incorporate the same basic design to be capable of the ultimate goal of "detecting" or "demodulating" intelligence from the human voice when that intelligence is residing within an electronic signal. The successful cochlear implant must also be capable of converting the pattern of the detected intelligence into an appropriate electronic format for application to the acoustic (eighth cranial) nerve, which in turn further transmits the encoded pattern to the hearing center of the brain, where the information is interpreted as meaningful intelligence. That is why implants from all (three) major manufacturers work equally well in functionality, but are quite different in final design enhancements. Design of this basic conversion process was first described by Adam Kissiah, Jr., and was first exposed to the public when it was revealed to James O. Harrell, Esquire, Patent Counsel to NASA's John F. Kennedy Space Center, in July, 1974. Mr. Harrell also advised exposure to another person capable of understanding the concept. This was done on August 1, 1974. Subsequent Patent Office search and patent application for letters patent was completed in May 1977. Patent 4063048 was issued to Adam M. Kissiah, Jr. on December 13, 1977; Reissue 31031, which further improved design, was issued in September 1982.
Some cochlear implant designs and intra-cochlear implantations were made by others (see Cochlear Technology by Adam M. Kissiah, Jr.) prior to the mid-1970s, and were considered "successful" from a surgical and medical point of view. An equal number of proclamations and claims of being "firsts" in cochlear implantation were also made. Indeed, many important advances in cochlear implantation were accomplished during the 1960s and '70s. These earlier implants were capable of providing background sounds, and provided some aid to lip reading, and thus enabled patients to attain a most welcome sense of "attachment" to the world of sound. These earlier implants were incapable, however, of providing the ultimate level of comprehension of the intelligence of the spoken human voice enjoyed by the implant users of today. This fact can be supported by review of the many volumes of quarterly reports provided by many researchers under contract to the National Institutes of Health.
Greater understanding of voice intelligence was accomplished as the designs described in this first patent for the Cochlear Implant (4063048, December 13, 1977) were utilized in subsequent cochlear implants. Although Adam Kissiah was a full-time employee with NASA at the Kennedy Space Center, he participated as a consultant in an implantation program during the early 1980s through license agreement granted by Kissiah to Biostim, Inc., who in turn participated (also by contractual agreement) with Stanford University, Dr. Robert L. White and Dr. F Blair Simmons, principal investigators, during their program of cochlear implants (See Stanford University Cochlear Implant Program).
In 1972 the House 3M single-electrode implant was the first to be commercially marketed.[9] However, it was Dr. Michelson's patents and ultimately device which are thought of as the first cochlear implants.[10]
In 1976 a paper (received Feb 1975) was published by Pialoux, Chouard and McLeod that stated that, in the six months before the paper's submission, seven patients were implanted with an eight-channel device.[11] Although it was reported that about 50% of ordinary words were understood without lipreading, this has not been supported by audiological data in the literature.
Parallel to the developments in California, in the 1970s there were two other groups working on the development of the cochlear implant in Vienna, Austria, and Melbourne, Australia. On December 16, 1977, professor Kurt Burian implanted a multichannel cochlear implant. The device was developed by the scientists Ingeborg Hochmair-Desoyer and Erwin Hochmair, who founded MED-EL, producer of hearing implants, in 1989.[12]
Professor Graeme Clark A.C., then Foundation Professor of the Department of Otolaryngology at the University of Melbourne in 1970, led the team that developed the Australian prototype bionic ear, which was implanted into the first patient, Rod Saunders, in 1978.
The prototype for the bionic ear developed by Professor Clark can be seen at the National Museum of Australia in Canberra, Australia. It is part of a collection acquired by the National Museum in 2009 and includes key elements that figured in the development of the bionic ear, including the prototype multi-channel cochlear implant received by Rod Saunders in 1978 (subsequently removed when it was failed and replaced by an updated model in 1983)[13] The updated model was a Nucleus 22, the world's first commercial multi-channel cochlear implant.[14]
In December 1984, the Australian cochlear implant was approved by the United States Food and Drug Administration to be implanted in adults in the United States. In 1990 the FDA lowered the approved age for implantation to two years, then 18 months in 1998, and finally 12 months in 2000,[15] although off-label use has occurred in babies as young as 6 months in the United States and 4 months internationally.[citation needed]
Throughout the 1990s, the large external components which had been worn strapped to the body grew smaller and smaller, thanks to developments in miniature electronics. By 2006, most school-age children and adults used a small behind-the-ear (BTE) speech processor about the size of a power hearing aid. Younger children have small ears and might mishandle behind-the-ear speech processors, therefore, they often wear the sound processor on their hip in a pack or small harness or wear the BTEs pinned to their collar, barrette or elsewhere.
In 1991, the systems changed from being converted through an analog compressor, now became digital. On October 5, 2005, the first of three recipients was implanted with Cochlear's TIKI device, a totally implantable cochlear implant, in Melbourne, Australia.[16] This was part of a research project conducted by Cochlear Ltd and the University of Melbourne Department of Otolaryngology under the umbrella of CRC HEAR to be the first cochlear implant system capable of functioning for sustained periods with no external components. The system is capable of providing hearing via the TIKI device in stand-alone mode (invisible hearing) or via an external sound processor. Although these recipients continue to use their devices successfully today, it will be many years before a commercial product becomes available.[17]
Since hearing in two ears allows people to localize sounds (given synchronised AGCs) and to hear better in noisy environments, bilateral (both ear) implants are being investigated and used. Users generally report better hearing with two implants, and tests show that bilateral implant users are better at localizing sounds and hearing in noise.[18] However, there is also evidence to suggest that the combination of one implant with an FM system provides better speech recognition in noise than two implants alone.[19] Additionally, dynamic FM technology has been proven to outperform traditional FM when used with cochlear implants.[20]
Nearly 3,000 people worldwide are bilateral cochlear implant users, including 1,600 children.[citation needed] As of 2006[update], the world's youngest recipient of a bilateral implant was just over 5 months old (163 days) in Germany (2004).[21] In April 2014, it was reported that the youngest-ever implant in the United Kingdom has been placed in a baby aged three months and three days.[22]
Parts of the cochlear implant[edit]
The implant is surgically placed under the skin behind the ear. The basic parts of the device include:
- External:
- one or more microphones which picks up sound from the environment
- a speech processor which selectively filters sound to prioritize audible speech, splits the sound into channels and sends the electrical sound signals through a thin cable to the transmitter,
- a transmitter, which is a coil held in position by a magnet placed behind the external ear, and transmits power and the processed sound signals across the skin to the internal device by electromagnetic induction,
- Internal:
- a receiver and stimulator secured in bone beneath the skin, which converts the signals into electric impulses and sends them through an internal cable to electrodes,
- an array of up to 22 electrodes wound through the cochlea, which send the impulses to the nerves in the scala tympani and then directly to the brain through the auditory nerve system. There are 4 manufacturers for cochlear implants, and each one produces a different implant with a different number of electrodes. The number of channels is not a primary factor upon which a manufacturer is chosen; the signal processing algorithm is also another important block.[citation needed]
There are a number of factors that determine the degree of success to expect from the operation and the device itself. Cochlear implant centers determine implant candidacy on an individual basis and take into account a person's hearing history, cause of hearing loss, amount of residual hearing, speech recognition ability, health status, and family commitment to aural habilitation/rehabilitation.
A prime candidate is described as:
- having severe to profound sensorineural hearing loss in both ears.
- having a functioning auditory nerve
- having lived at least a short amount of time without hearing (approximately 70+ decibel hearing loss, on average)
- having good speech, language, and communication skills, or in the case of infants and young children, having a family willing to work toward speech and language skills with therapy
- not benefitting enough from other kinds of hearing aids, including latest models of high power hearing instruments and FM systems
- having no medical reason to avoid surgery
- living in or desiring to live in the "hearing world"
- having realistic expectations about results
- having the support of family and friends
- having appropriate services set up for post-cochlear implant aural rehabilitation (through a speech language pathologist, deaf educator, or auditory verbal therapist).
Type of hearing loss[edit]
People with mild or moderate sensorineural hearing loss are generally not candidates for cochlear implantation. Their needs can often be met with hearing aids alone or hearing aids with an FM system. After the implant is put into place, sound no longer travels via the ear canal and middle ear but will be picked up by a microphone and sent through the device's speech processor to the implant's electrodes inside the cochlea. Thus, most candidates have been diagnosed with a severe or profound sensorineural hearing loss.
The presence of auditory nerve fibers is essential to the functioning of the device: if these are damaged to such an extent that they cannot receive electrical stimuli, the implant will not work. Some individuals with severe auditory neuropathy may also benefit from cochlear implants.
Age of recipient[edit]
Post-lingually deaf adults, pre-lingually deaf children and post-lingually hard of hearing people (usually children) who have lost hearing due to diseases such as CMV and meningitis, form three distinct groups of potential users of cochlear implants with different needs and outcomes. Those who have lost their hearing as adults were the first group to find cochlear implants useful, in regaining some comprehension of speech and other sounds. The outcomes of individuals that have been deaf for a long period of time before implantation are sometimes astonishing, although more variable.
The risk of surgery in the older patient must be weighed against the improvement in quality of life. As the devices improve, particularly the sound processor hardware and software, the benefit is often judged to be worth the surgical risk, particularly for the newly deaf elderly patient.[23]
Another group of customers are parents of children born deaf who want to ensure that their children grow up with good spoken language skills. The brain develops after birth and adapts its function to the sensory input; absence of this has functional consequences for the brain, and consequently congenitally deaf children who receive cochlear implants at a young age (less than 2 years) have better success with them than congenitally deaf children who first receive the implants at a later age,[24] though the critical period for utilizing auditory information does not close completely until adolescence. One doctor has said "There is a time window during which they can get an implant and learn to speak. From the ages of two to four, that ability diminishes a little bit. And by age nine, there is zero chance that they will learn to speak properly. So it's really important that they get recognized and evaluated early."[25] Additionally, there is another sensitive period for strong asymmetry in hearing that closes earlier in life. In cases of early single-sided deafness or unilateral cochlear implantation the brain reorganizes towards the hearing ear and that puts the deaf ear into a disadvantage.[26] Consequently, the benefit of a sequential second implantation (on the deaf ear) is critically dependent on the delay between implantations.[27] Periods of asymmetric hearing during early childhood should be avoided and therapy of deafness should be binaural.
The third group who will benefit substantially from cochlear implantation are post-lingual subjects who have lost hearing: a common cause is childhood meningitis. Young children (under five years) in these cases often make excellent progress after implantation because they have learned how to form sounds, and only need to learn how to interpret the new information in their brains.
Number of users[edit]
By the end of 2008, the total number of cochlear implant recipients had grown to an estimated 150,000 worldwide.[28] A story in 2000 stated that one in ten deaf children in the United States had a cochlear implant, and that the projection was the ratio would rise to one in three in ten years.[29]
Mexico had performed only 55 cochlear implant operations by the year 2000 (Berruecos 2000). Taiwan and China announced an approximately $270 million order for cochlear implant devices for children in 2006, which are being paid for by major healthcare organization based in Taipei. These cochlear implants are a donation by the Taiwanese organization[30][31]
In India, there are an estimated 1 million profoundly deaf children, only about 5,000 have cochlear implants. This minuscule number is due to the high costs for the implant, as well as subsequent therapy.[32]
The operation, post-implantation therapy and ongoing effects[edit]
The device is surgically implanted under a general anesthetic or local anesthetic without or with sedation,[33] and the operation usually takes from 1½ to 5 hours. First a small area of the scalp directly behind the ear may be shaved and cleaned. Then an incision is made in the skin behind the ear and the surgeon drills into the mastoid bone, creating a pocket for the receiver/stimulator, and then into the inner ear where the electrode array is inserted into the cochlea. The patient normally goes home the same day or the day after the surgery, although some cochlear implant recipients stay in the hospital for 1 to 2 days. As with every medical procedure, the surgery involves a certain amount of risk; in this case, the risks include skin infection, onset of (or change in) tinnitus, damage to the vestibular system, and damage to facial nerves that can cause muscle weakness, impaired facial sensation, or, in the worst cases, facial paralysis. There is also the risk of device failure, usually where the incision does not heal properly. This occurs in 2% of cases and the device must be removed.[citation needed] The operation also destroys some or all of the residual hearing the patient may have in the implanted ear because of the shaving of hair cells in the cochlea; as a result, some doctors advise single-ear implantation, saving the other ear in case a biological treatment becomes available in the future.
After 1–4 weeks of healing (the wait is usually longer for children than adults), the implant is "activated" by connecting an external sound processor to the internal device via a magnet. Initial results vary widely, and post-implantation therapy is required as well as time for the brain to adapt to hearing new sounds. In the case of congenitally deaf children, audiological training and speech therapy typically continue for years, though infants can become age appropriate—able to speak and understand at the same level as a hearing child of the same age. The participation of the child's family in working on spoken language development is considered to be even more important than therapy, because the family can aid development by participating actively—and continually—in the child's therapy, making hearing and listening interesting, talking about objects and actions, and encouraging the child to make sounds and form words. Professionals trained to work with children who have received cochlear implants are a major part of the parent-professional team when addressing the task of teaching children to use their hearing to develop speech and spoken language. These professionals include, but are not limited to:
- Speech-Language Pathologists (SLP)
- Certified Auditory-Verbal Therapists (LSLS Cert. AVT)
- Pediatric Audiologist (AuD)
- Teacher of the Deaf (ToD) with a specialization in Oral Deaf Education
Some users, audiologists, and surgeons also report that when there is an ear infection causing fluid in the middle ear, it can affect the cochlear implant, leading to temporarily reduced hearing.[citation needed]
The implant has a few effects unrelated to hearing. Manufacturers have cautioned against scuba diving due to the pressures involved, but the depths found in normal recreational diving appear to be safe. The external components must be turned off and removed prior to swimming or showering, except for users of the Advanced Bionics Neptune processor, which is waterproof. In most cases, certain diagnostic tests such as magnetic resonance imaging (MRI) cannot be used on patients with cochlear implants without first removing the small internal magnet (an outpatient procedure usually performed with a local anesthetic), but some implants are now FDA approved for use with certain strengths of MRI machine. Large amounts of static electricity can cause the device's memory to reset. For this reason, children with cochlear implants are also advised to avoid plastic playground slides.[34] The electronic stimulation the implant creates appears to have a positive effect on the nerve tissue that surrounds it.[35]
In the United States, medical costs run from US$45,000 to US$125,000; this includes evaluation, the surgery itself, hardware (device), hospitalization and rehabilitation. Some or all of this may be covered by health insurance. In the United Kingdom, the NHS covers cochlear implants in full, as does Medicare in Australia, and the Department of Health[36] in Ireland, Seguridad Social in Spain and Israel, and the Ministry of Health or ACC (depending on the cause of deafness) in New Zealand. According to the US National Institute on Deafness and Other Communication Disorders, the estimated total cost is $60,000 per person implanted.
A study by Johns Hopkins University determined that for a three-year-old child who receives cochlear implants can save $30,000 to $50,000 in special-education costs for elementary and secondary schools as they are more likely to be mainstreamed in school and thus use fewer support services than similarly deaf children.[37]
A cochlear implant will not cure deafness, but is a prosthetic substitute for hearing. Some recipients find them very effective, others somewhat effective and some feel worse overall with the implant than without.[38] For people already functional in spoken language who lose their hearing, cochlear implants can be a great help in restoring functional comprehension of speech, especially if they have only lost their hearing for a short time.
Individuals who have acquired deafblindness (loss of hearing and vision combined) may find cochlear implants a radical improvement in their daily lives. It may provide them with more information for safety, communication, balance, orientation and mobility and promote interaction within their environment and with other people, reducing isolation. Having more auditory information than they may be familiar with may provide them with sensory information that will help them become more independent.
British Member of Parliament Jack Ashley received a cochlear implant in 1994 at age 70 after 25 years of deafness, and reported that he has no trouble speaking to people he knows; whether one on one or even on the telephone, although he might have difficulty with a new voice or with a busy conversation, and still had to rely to some extent on lip reading. He described the robotic sound of human voices perceived through the cochlear implant as "a croaking Dalek with laryngitis". Another recipient described the initial sounds as similar to radio static and voices as being cartoonish, though after a year with the implant she said everything sounded right.[39] Even modern cochlear implants have at most 22 electrodes to replace the 16,000 delicate hair cells that are used for normal hearing. However, the sound quality delivered by a cochlear implant is often good enough that many users do not have to rely on lip reading in quiet conditions. In noisy conditions however, speech understanding often remains poor.[40]
Adults who have grown up deaf can find the implants ineffective or irritating. This relates to the specific pathology of deafness and the time frame. Adults who are born with normal hearing and who have had normal hearing for their early years and who have then progressively lost their hearing tend to have better outcomes than adults who were born deaf. This is due to the neural patterns laid down in the early years of life, which are crucially important to speech perception. Cochlear implants cannot overcome such a problem. Some who were orally educated and used amplifying hearing aids have been more successful with cochlear implants, as the perception of sound was maintained through use of the hearing aid. Daily exercises such as side by side tracking, listening to audio books while reading a print book, synthetic training, and analytic training can improve the efficacy of an implant through practice.[41]
Children without a working auditory nerve may be helped with a cochlear implant, although the results may not be optimal. Patients without a viable auditory nerve are usually identified during the candidacy process. Fewer than 1% of deaf individuals have a missing or damaged auditory nerve, which today can be treated with an auditory brainstem implant. Research published in 2005 has suggested that children and adults can benefit from bilateral cochlear implants in order to aid in sound localization and speech understanding,[42] and a 2011 study indicated that the language skills of children with two implants were within the normal range for the age.[43]
Efficacy of cochlear implantation in the setting of otosclerosis has been demonstrated.[44]
Risks and disadvantages[edit]
Some effects of implantation are irreversible; while the device promises to provide new sound information for a recipient, the implantation process inevitably results in shaving of the hair cells within the cochlea,[45] which can result in a permanent loss of some or all residual natural hearing. While recent improvements in implant technology, and implantation techniques, promise to minimize such damage, the risk and extent of damage still varies. The goal of new implantation techniques is to reduce the risk of infection, operating time, and complications while improving the patient's ability to hear. Such improvements of implantation techniques include preserving low frequency hearing and using minimal invasive surgery to better secure the device.[46][47] Still, the cause of deafness is not always identified before the surgery. It is possible but rare that the surgery does not restore hearing at all.
The United States Food and Drug Administration reports that cochlear implant recipients may be at higher risk for meningitis.[48] A study of 4,265 American children who received implants between 1997 and 2002 concluded that recipient children had a risk of pneumococcal meningitis more than 30 times greater than that for children in the general population.[49] A later, UK-based, study found that while the incidence of meningitis in implanted adults was significantly higher than the general population, the incidence in children was no different from the general population.[50] As a result, the Centers for Disease Control and Prevention and the Food and Drug Administration both recommend that would-be implant recipients be vaccinated against meningitis prior to surgery.[51]
Rarely, necrosis has been observed in the skin flaps surrounding cochlear implants.[52][53] Hyperbaric oxygen has been shown to be a useful adjunctive therapy in the management of cochlear implant flap necrosis.[54]
As the location of the cochlea is close to the facial nerve, there is a risk that the nerve may be damaged during the operation. The incidence of the damage is infrequent.[55]
There are strict protocols in choosing candidates to avoid risks and disadvantages. A battery of tests is performed to make the decision of candidacy easier. For example, some patients suffer from deafness medial to the cochlea - typically vestibular schwannomas. Implantation into the cochlea has a low success rate with these people, as the artificial signal does not have a healthy nerve to travel along. Historically, patients with severe congenital anatomic anomalies of the cochlea were considered poor candidates for cochlear implantation. Many studies since the 1980s have demonstrated successful hearing outcomes after CI in this group. Blake Papsin et al. in 2005 published the largest series of patients with cochleovestibular anomalies undergoing implantation and found no significant difference in outcomes versus patients with normal anatomy.[56] Michael Pakdaman et al. in 2012 presented a systematic review of studies reviewing cochlear implantation in anomalous inner ears and found increased surgical difficulty and lower speech perception among patients with more severe inner ear dysplasia.[57] With careful selection of candidates, the risks of implantation are minimized.
The implant works by using the tonotopic organization of the basilar membrane of the inner ear. "Tonotopic organization", also referred to as a "frequency-to-place" mapping, is the way the ear sorts out different frequencies so that our brain can process that information. In a normal ear, sound vibrations in the air lead to resonant vibrations of the basilar membrane inside the cochlea. High-frequency sounds (i.e. high pitched sounds) do not pass very far along the membrane, but low frequency sounds pass farther in. The movement of hair cells, located all along the basilar membrane, creates an electrical disturbance that can be picked up by the surrounding nerve cells. The brain is able to interpret the nerve activity to determine which area of the basilar membrane is resonating, and therefore what sound frequency is being heard.
In individuals with sensorineural hearing loss, hair cells are often fewer in number and/or damaged. Hair cell loss or absence may be caused by a genetic mutation or an illness such as meningitis. Hair cells may also be destroyed chemically by an ototoxic medication, or simply damaged over time by excessively loud noises. The cochlear implant bypasses the hair cells and stimulates the cochlear nerves directly using electrical impulses. This allows the brain to interpret the frequency of sound as it would if the hair cells of the basilar membrane were functioning properly (see above).
Sound received by the microphone must next be processed to determine how the electrodes should be activated.
Filterbank strategies use fast Fourier transforms (FFTs) to divide the signal into different frequency bands. The algorithm chooses a number of the strongest outputs from the filters, the exact number depending on the number of implanted electrodes and other factors. These strategies emphasize transmission of the spectral aspects of speech. Although coarse temporal information is presented, the fine timing aspects are as yet poorly perceived, and this is the focus of much current research.
Feature extraction strategies use features which are common to all vowels. Each vowel has a fundamental frequency (the lowest frequency peak) and formants (peaks with higher frequencies). The pattern of the fundamental and formant frequencies is specific for different vowel sounds. These algorithms try to recognize the vowel and then emphasize its features. These strategies emphasize the transmission of spectral aspects of speech. Feature extraction strategies are no longer widely used. Cochlear implant manufacturer use various coding strategies. Cochlear Americas, for example, uses the Speak-ACE strategy. ACE is mainly used, in which number of maxima (n) from the available maxima in sound are selected. Advanced Bionics uses other techniques like CIS, SAS, HiRes, and Fidelity 120, which stimulate the full spectrum. The processing strategy is a main block upon which one has to choose the implant manufacturer. Research shows that patients can understand speech with at least 4 electrodes, but a greater obstacle is in music perception, where it returns that fine structure stimulation is an important issue. Some strategies used in Advanced Bionics and MED-EL devices make use of fine structure presentation by implementing the Hilbert transform in the signal processing path, while ACE strategies depends mainly on the short time Fourier transform.
This is used to transmit the processed sound information over a radio frequency link to the internal portion of the device. Radio frequency is used so that no physical connection is needed, which reduces the chance of infection and pain. The transmitter attaches to the receiver using a magnet that holds through the skin.
This component receives directions from the speech processor by way of magnetic induction sent from the transmitter. (The receiver also receives its power through the transmission.) The receiver is also a sophisticated computer that translates the processed sound information and controls the electrical current sent to the electrodes in the cochlea. It is embedded in the skull behind the ear.
Electrode array[edit]
The electrode array is made from a type of silicone rubber, while the electrodes are platinum or a similar highly conductive material. It is connected to the internal receiver on one end and inserted into the cochlea deeper in the skull. (The cochlea winds its way around the auditory nerve, which is tonotopically organized as is the basilar membrane). When an electrical current is routed to an intracochlear electrode, an electrical field is generated and auditory nerve fibers are stimulated.
In the devices manufactured by Cochlear Ltd, two electrodes sit outside the cochlea and act as grounds—one is a ball electrode that sits beneath the skin, while the other is a plate on the device. This equates to 24 electrodes in the Cochlear-brand 'nucleus' device, 22 array electrodes within the cochlea and 2 extra-cochlear electrodes.
Insertion depth is another important factor. The mean length of human being cochlea is 33–36 millimetres (1.3–1.4 in), due to some physical limitation, the implants don't reach to the apical tip when inserted but it may reach up to 25 millimetres (0.98 in) which corresponds to a tonotopical frequency of 400–6000 Hz. MED-EL produces deep insertion implants that can be inserted up to a tonotopical frequency of 100 Hz (according to Greenwood frequency to position formula in normal hearing), but the distance between the electrodes is about 2.5 millimetres (0.098 in), while in the Nucleus Freedom from Cochlear Ltd is about 0.7 millimetres (0.028 in). There is a strong research in this direction and the best sounding implant can be subjective from patient to patient.
Speech processors[edit]
Speech processors are the components of the cochlear implant that transforms the sounds picked up by the microphone into electronic signals capable of being transmitted to the internal receiver. The coding strategies programmed by the user's audiologist are stored in the processor, where it codes the sound accordingly. The signal produced by the speech processor is sent through the coil to the internal receiver, where it is picked up by radio signal and sent along the electrode array in the cochlea.
There are primarily two forms of speech processors available. The most common kind is called the "behind-the-ear" processor, or BTE. It is a small processor that is worn on the ear, typically together with the microphone. This is the kind of processor used by most adults and older children. Babies and small children wear either a "baby" BTE (pinned or clipped to the collar) or the body-worn processor, which was more common in previous years. Today's tiny processors can often take the place of bulky body-worn processors. MED-EL and Cochlear brands both carry a "baby BTE" configurations.
Programming the speech processor[edit]
The audiologist sets the minimum and maximum current level outputs for each electrode in the array based on the user's reports of loudness. The audiologist also selects the appropriate speech processing strategy and program parameters for the user.
Scientific and technical advances[edit]
Professor Graeme Clark A.C. of La Trobe University, Melbourne, Australia, in 2008, announced beginning the development of a prototype "hi fi" cochlear implant featuring 50 electrodes. It is hoped that the increased number of electrodes will enable users to perceive music and discern specific voices in noisy rooms.[58]
Researchers at Northwestern University have used infrared light to directly stimulate the neurons in the inner ear of deaf guinea pigs while recording electrical activity in the inferior colliculus, an area of the midbrain that acts as a bridge between the inner ear and the auditory cortex. The laser stimulation produced more precise signals in that brain region than the electrical stimulation commonly used in cochlear implants.[59] Laser stimulation is a promising technology for improving the auditory resolution of implants but further research using fiber optics to stimulate the neurons of the inner ear is required before products using the technology can be developed.
Cochlear implants are rarely used in ears that have a functional level of residual hearing. However, Electric Acoustic Stimulation (EAS) devices, including the Hybrid "short-electrode" cochlear implant, have been developed that combine a cochlear implant with a sound amplifying hearing aid.[60][61] EAS devices have the potential to make cochlear implants suitable for many people with partial hearing loss. The sound amplifying component helps users to perceive lower frequency sounds through their residual natural hearing while the cochlear implant allows them to hear middle and higher frequency sounds. The combination enhances speech perception in noisy environments.[62]
Additionally, work is ongoing in developing a fully internal cochlear implant. As of April 2011, four people have undergone a trial of an internal microphone system, with two more yet to come.[63]
Currently (as of 2013[update]), the three cochlear implant devices approved for use in the U.S. are manufactured by Cochlear Limited (Australia), Advanced Bionics (USA, a division of Sonova) and MED-EL (Austria). In Europe, Africa, Asia, South America, and Canada, an additional device manufactured by Neurelec (France, a division of William Demant) is available. Lastly, a device made by Nurotron (China) is available in some parts of the world. Each manufacturer has adapted some of the successful innovations of the other companies to its own devices. There is no clear-cut consensus that any one of these implants is superior to the others. Users of all four devices display a wide range of performance after implantation.
Since the devices have a similar range of outcomes, other criteria are often considered when choosing a cochlear implant: FM system compatibility, usability of external components, cosmetic factors, battery life, reliability of the internal and external components, MRI compatibility, mapping strategies, customer service from the manufacturer, the familiarity of the user's surgeon and audiologist with the particular device, and anatomical concerns.
There have been news reports of other organizations working to develop cochlear implants in India by a branch of the Defence Research and Development Organisation[64] (which is expected to reach the clinical trial stage around September 2012[65]) and in South Korea by the Seoul National University Hospital.[66]
Criticism and Controversy[edit]
Much of the strongest objection to cochlear implants has come from the Deaf community, which consists largely of pre-lingually deaf people whose first language is a signed language. For some in the Deaf community, cochlear implants are an affront to their culture, which as they view it, is a minority threatened by the hearing majority.[67] This is an old problem for the deaf community, going back as far as the 18th century with the argument of manualism vs. oralism. This is consistent with medicalisation and the standardisation of the 'normal' body in the 19th century, when differences between normal and abnormal began to be debated.[68] Despite the cochlear implant being justified from a medical perspective, it is also important to consider the sociocultural context, particularly in regards to the Deaf community, which considers itself to possess its own unique language and culture.[69] This accounts for the cochlear implant being seen as an affront to their culture, as many do not believe that deafness is something that needs to be cured. However, it has also been argued that this does not necessarily have to be the case; the cochlear implant can act as a tool Deaf people can use to access the 'hearing world' without losing their Deaf identity.[69]
Cochlear implants for congenitally deaf children are considered to be most effective when implanted at a young age, during the critical period in which the brain is still learning to interpret sound.[25] Hence they are implanted before the recipients can decide for themselves, on the assumption that deafness is a disability. Deaf culture critics argue that the cochlear implant and the subsequent therapy often become the focus of the child's identity at the expense of a possible future deaf identity and ease of communication in sign language, and claim that measuring the child's success only by their mastery of hearing and speech will lead to a poor self-image as "disabled" (because the implants do not produce normal hearing) rather than having the healthy self-concept of a proudly deaf person.[70]
Children with cochlear implants are more likely to be educated orally, in the standard fashion, and without access to sign language (Spencer et al. 2003). They are often isolated from other deaf children and from sign language (Spencer 2003). Children do not always receive support in the educational system to fulfill their needs as they may require special education environments and Educational Assistants. According to Johnston (2004), cochlear implants have been one of the technological and social factors implicated in the decline of sign languages in the developed world. Some of the more extreme responses from Deaf activists have labeled the widespread implantation of children as "cultural genocide".[29] Andrew Solomon of the New York Times states that "Much National Association of the Deaf propaganda about the danger of implants is alarmist; some of it is positively inaccurate."[71]
Opposition continues today but is softening. As the trend for cochlear implants in children grows, deaf-community advocates have tried to counter the "either or" formulation of oralism vs manualism with a "both and" approach; some schools now are successfully integrating cochlear implants with sign language in their educational programs.[citation needed]
See also[edit]
- Auditory brainstem implant
- Bone conduction
- Brain implant
- Ear trumpet
- Electric Acoustic Stimulation
- Hearing Aid
- Neuroprosthetics
- Noise health effects
- Visual prosthesis
- ^ NIH Publication No. 11-4798 (2013-11-01). "Cochlear Implants". National Institute on Deafness and Other Communication Disorders. "According to the Food and Drug Administration (FDA), as of December 2012, approximately 324,200 people worldwide have received implants. In the United States, roughly 58,000 adults and 38,000 children have received them."
- ^ Ahmed, Nabila (2007-02-14). "Cochlear heads for earnings record". The Age. Retrieved 2008-04-27.
- ^ M.D. Eisen (1976). "Djourno, Eyries, and the first implanted electrical neural stimulator to restore hearing.". Otology & neurotology 24(3: 500–506. PMID 12806307.
- ^ Martin, Douglas (2012-12-15). "Dr. William F. House, Inventor of Pioneering Ear-Implant Device, Dies at 89". New York Times. Retrieved 2012-12-16.
- ^ W.F. House (May–June 1976). "Cochlear implants". Annals of Otology, Rhinology, and Laryngology. 85 (suppl 27) (3Pt2): 1–93. PMID 779582.
- ^ F. Blair Simmons (July 1966). "Electrical Stimulation of the Auditory Nerve in Man". Archives of Otolaryngology 84 (1): 2–54. doi:10.1001/archotol.1966.00760030004003. PMID 5936537.
- ^ References: Michelson RP, Merzenich MM,Pettit, Schindler RAc, "A cochlear prosthesis: Further clinical observations; preliminary results of physiological studies," presented at the Meeting of the Western Section of the American Laryngological, Rhinological and Otological Society, Inc., Pebble Beach, Calif., February 2, 1973.
- ^ Waltzman, SB, Roland, TJ, Cochlear Implants, 2nd edition, Chapter 1, pp1-10
- ^ "History of Cochlear Implants".
- ^ See Robin Michelson's patents here: Patent Patent 2.3M Power Point Presentation on the Cochlear Implant.
- ^ P. Pialoux?, C. H. Chouard? and P. Macleod? (1976). "Physiological and Clinical Aspects of the Rehabilitation of Total Deafness By Implantation of Multiple Intracochlear Electrodes". Acta Oto-laryngologica 81 (3-6): 436–441. doi:10.3109/00016487609119982. PMID 1274555.
- ^ Burian K, Hochmair E, Hochmair-Desoyer IJ. Lesser MR (1979)
- ^ Bionic ear prototype, National Museum of Australia
- ^ http://jama.jamanetwork.com/article.aspx?articleid=1735678
- ^ "Cochlear Implants".
- ^ Briggs, RJ; HC Eder, PM Seligman, RS Cowan, KL Plant, J Dalton, DK Money, JF Patrick (February 2008). "Initial clinical experience with a totally implantable cochlear implant research device". Otology & Neurotology 29 (2): 114–119. doi:10.1097/MAO.0b013e31814b242f. PMID 17898671.
- ^ "The Cooperative Research Centre for Cochlear Implant and Hearing Aid Innovation: Annual Report 2006/2007" (PDF). Retrieved 2008-04-27.[dead link]
- ^ Dave Tenenbaum (2010-01-11). "Study: Second cochlear implant can restore two important facets of binaural hearing". University of Wisconsin-Madison News. Retrieved 2010-01-12.
- ^ Erin C. Schafer, Linda M. Thibodeau (December 2006). "Speech Recognition in Noise in Children With Cochlear Implants While Listening in Bilateral, Bimodal, and FM-System Arrangements". American Journal of Audiology 15: 114–126. doi:10.1044/1059-0889(2006/015).
- ^ Jace Wolfe, Erin C. Schafer, Benjamin Heldner, Hans Mülder, Emily Ward, Brandon Vincent (2009). "Evaluation of Speech Recognition in Noise with Cochlear Implants and Dynamic FM". Journal of the American Academy of Audiology 20: 409–421. doi:10.3766/jaaa.20.7.3.
- ^ Mary Ann Moon. "Article: Cochlear implant is the first step in long journey.". Pediatric News. Archived from the original on 2002-05-01. Retrieved 2010-01-25.
- ^ Dreaper, Jane (2014-04-08). "Baby is 'youngest in UK' to have cochlear implants". bbc.com. Retrieved 8 April 2014.
- ^ Shapiro, Joseph (2005-12-20). "Elderly with Hearing Loss Turning to Cochlear Implants". Day to Day (National Public Radio). Retrieved 2008-04-27.
- ^ Kral A, O'Donoghue GM. Profound Deafness in Childhood. New England J Medicine 2010: 363; 1438-50
- ^ a b Paul Oginni (2009-11-16). "UCI Research with Cochlear Implants No Longer Falling on Deaf Ears". New University. Retrieved 2009-11-18.
- ^ Kral A et al. (2013) Single-sided deafness leads to unilateral aural preference within an early sensitive period. Brain 136; 180-193 http://brain.oxfordjournals.org/content/136/1/180.short
- ^ Gordon et al. (2013) Bilateral input protects the cortex from unilaterally-driven reorganization in children who are deaf. Brain 136; 1609-1625 http://brain.oxfordjournals.org/content/136/5/1609.long
- ^ van der Heijden, Dennis (2006-03-01). "What are Cochlear Implants?". Axistive. Retrieved 2007-03-01.
- ^ a b Amy E. Nevala (2000-09-28). "Not everyone is sold on the cochlear implant". Seattle Post-Intelligencer. Retrieved 2009-11-04.
- ^ "Cochlear Corp. News".
- ^ "Cochlear Corp. News".
- ^ Priyanka Golikeri (2010-07-14). "Costly cochlear implants beyond reach of masses". dnaindia.com. Retrieved 14 July 2010.
- ^ http://www.ncbi.nlm.nih.gov/pubmed/23187931
- ^ Dotinga, Randy (2006-08-06). "Slides: a playground menace". Wired. Retrieved 2008-04-27.
- ^ Solomon, Andrew (1994-08-28). "Defiantly deaf". New York Times Magazine. Retrieved 2008-04-27.
- ^ http://beaumont.ie/index.jsp?p=350&n=407&a=0
- ^ John M. Williams (2000-05-05). "Do Health-Care Providers Have to Pay for Assistive Tech?". Business Week. Retrieved 2009-10-25.
- ^ Delost, Shelli; Sarah Lashley (2000-03). "The Cochlear Implant Controversy". Drury Interdisciplinary Research Conference. Retrieved 2008-04-27.
- ^ Rempp, Kerri (2009-06-11). "City clerk outsmarts heredity". The Chaldron Record. Retrieved 2009-06-19.
- ^ Erin C. Schafer, Linda M. Thibodeau (2004). "Speech recognition abilities of adults using CIs interfaced with FM systems". Journal of the American Academy of Audiology. 15(10): 678–691.
- ^ Tools for Improving Listening Skills, Hope: Cochlear (Re) Habilitation Resources, http://hope.cochlearamericas.com/Tools-for-Improving-Listening-Skills
- ^ Offeciers E, Morera C, Müller J, Huarte A, Shallop J, Cavallé L. (Sep 2005). "International consensus on bilateral cochlear implants and bimodal stimulation". Acta Otolaryngol. 125 (9): 918–919. doi:10.1080/00016480510044412. PMID 16109670.
- ^ Tenenbaum, David (2011-10-24). "Deaf children: Study shows significant language progress after two cochlear implants (Oct. 24, 2011)". news.wisc.edu. Retrieved 25 October 2011.
- ^ Marshall AH, Fanning N, Symons S, Shipp D, Chen JM, Nedzelski JM. Cochlear implantation in cochlear otosclerosis. Laryngoscope. 2005 October; 115(10):1728-1733.
- ^ http://www.surgeryencyclopedia.com/Ce-Fi/Cochlear-Implants.html
- ^ Gstoettner, W., Kiefer, J., Baumgartner, W., Pok, S., Peters, S., Adunka, O. (2004). Hearing preservation in cochlear implantation for electric acoustic stimulation. Acta Oto-Laryngologica, 124(4): 348-352
- ^ Monksfield, P., Husseman, J., Cowan, R., O'Leary, S., & Briggs, R. (2012) The new nucleus 5 model cochlear implant: A new surgical technique and early clinical results. Cochlear Implants International: An Interdisciplinary Journal, 13(3): 142-147
- ^ "FDA Public Health Notification: Risk of Bacterial Meningitis in Children with Cochlear Implants". FDA. July 24, 2002. Archived from the original on 2008-09-25. Retrieved 2008-11-09.
- ^ Biernath, K. R.; Reefhuis, J; Whitney, CG; Mann, EA; Costa, P; Eichwald, J; Boyle, C. "Bacterial Meningitis Among Children With Cochlear Implants Beyond 24 Months After Implantation - Biernath et al. 117 (2): 284 - Pediatrics". Pediatrics 117 (2): 284. doi:10.1542/peds.2005-0824. PMID 16390918. Retrieved 2008-11-09.
- ^ "Incidence of meningitis and of death from all causes among users of cochlear implants in the United Kingdom - Summerfield et al., 10.1093/pubmed/fdh188 - Journal of Public Hea...". doi:10.1093/pubmed/fdh188. Retrieved 2008-11-09.
- ^ "Maryland Hearing and Balance Center". University of Maryland Medical Center. Retrieved 2009-10-25.
- ^ Haberkamp TJ, Schwaber MK (January 1992). "Management of flap necrosis in cochlear implantation". Ann. Otol. Rhinol. Laryngol. 101 (1): 38–41. PMID 1728883.
- ^ Stratigouleas ED, Perry BP, King SM, Syms CA (September 2006). "Complication rate of minimally invasive cochlear implantation". Otolaryngol Head Neck Surg 135 (3): 383–6. doi:10.1016/j.otohns.2006.03.023. PMID 16949968. Retrieved 2009-04-01.
- ^ Schweitzer VG, Burtka MJ (1990). "Hyperbaric Oxygen Therapy in the Management of Cochlear Implant Flap Necrosis.". J. Hyperbaric Med 5 (2): 81–90. Retrieved 2009-04-01.
- ^ Patricia M. Chute; Mary Ellen Nevins (2002). The Parents' Guide to Cochlear Implants. Gallaudet University Press. p. 44. ISBN 1-56368-129-3.
- ^ Papsin, BC (January 2005). "Cochlear implantation in children with anomalous cochleovestibular anatomy.". The Laryngoscope 115 (1 Pt 2 Suppl 106): 1–26. doi:10.1097/00005537-200501001-00001. PMID 15626926.
- ^ Pakdaman, MN; Herrmann, BS, Curtin, HD, Van Beek-King, J, Lee, DJ (Dec 1, 2011). "Cochlear Implantation in Children with Anomalous Cochleovestibular Anatomy: A Systematic Review.". Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. doi:10.1177/0194599811429244. PMID 22140206.
- ^ Cochlear implant maker says hi-fi bionic ear will help the deaf hear music. News.com.au, December 18, 2008.
- ^ Nowak, R. (2008). Light opens up a world of sound for the deaf. New Scientist.
- ^ UT Southwestern Medical Center (2008, April 28). New Hybrid Hearing Device Combining Advantages Of Hearing Aids, Implants. ScienceDaily. Retrieved December 22, 2008, from http://www.sciencedaily.com /releases/2008/04/080417100013.htm
- ^ Gantz, B.G. and Turner, C.W. (2004) Combining acoustic and electrical speech processing: Iowa/Nucleus hybrid implant. Acta Otolaryngol 124: 344-347. See also: http://www.nationalreviewofmedicine.com/issue/2006/03_30/3_advances_medicine02_6.html
- ^ Turner, C.W., Gantz, B.J., Vidal, C., et al. (2004) Speech recognition in noise for cochlear implant listeners: Benefits of residual acoustic hearing J. Acoust. Soc. Am. Volume 115, Issue 4, pp. 1729-1735.
- ^ Graham-Rowe, Duncan (2011-04-04). "Ear implants for the deaf with no strings attached - tech - 04 April 2011 - New Scientist". newscientist.com. Retrieved 5 April 2011.
- ^ "Cheaper, lighter biomedical equipment using Def-tech". Zee News. 2010-03-05. Retrieved 2010-03-05.
- ^ "Defence Research and Development Organisation develops affordable cochlea implant". indiatimes.com. 2012-05-20. Retrieved 20 May 2012.
- ^ Bae Ji-sook (2010-02-28). "Procedure Gives Hearing to Auditory Disabled". The Korea Times. Retrieved 2010-03-05.
- ^ "The Cochlear Implant Controversy, Issues And Debates". NEW YORK: CBS News. September 4, 2001. Retrieved 2008-11-09.
- ^ Lock, M. and Nguyen, V-K., An Anthropology of Biomedicine, Oxford, Wiley-Blackwell, 2010.
- ^ a b Power, D., 'Models of Deafness: Cochlear Implants in the Australian Daily Press', Journal of Deaf Studies and Deaf Education, vol. 10, no. 4, 2005, pp. 451-459.
- ^ NAD Cochlear Implant Committee. "Cochlear Implants". Archived from the original on 2007-02-20.
- ^ Solomon, Andrew (1994-08-28). "Defiantly deaf". The New York Times. Retrieved 2010-04-30.
Further reading[edit]
- A wide range of information and activities designed to help recipients and the professionals they work with develop or re-learn listening and language skills - http://www.cochlear.com/wps/wcm/connect/in/home/connect/rehabilitation-resources/rehabilitation-resources
- Berruecos, Pedro. (2000). Cochlear implants: An international perspective - Latin American countries and Spain. Audiology. Hamilton: Jul/Aug 2000. Vol. 39, 4:221-225
- House, W. F., Cochlear Implants. Ann Otol Rhinol Larynogol 1976; 85 (suppl 27): 1 – 93.
- Simmons, F. B., Electrical Stimulation of the Auditory Nerve in Man, Arch Otolaryng, Vol 84, July 1966
- Pialoux, P., Chouard, C. H. and MacLeod, P. 1976. Physiological and clinical aspects of the rehabilitation of total deafness by implantation of multiple intracochlear electrodes. Acta Oto-Laryngologica 81: 436-441
- Chorost, Michael. (2005). Rebuilt: How Becoming Part Computer Made Me More Human. Boston: Houghton Mifflin.
- Christiansen, John B. (2010) Reflections: My Life in the Deaf and Hearing Worlds. Washington, DC: Gallaudet University Press.
- Christiansen, John B., and Irene W. Leigh (2002,2005). Cochlear Implants in Children: Ethics and Choices. Washington, DC: Gallaudet University Press.
- Cooper, Huw R. and Craddock, Louise C. (2006)Cochlear Implants A Practical Guide. London and Philadelphia: Whurr Publishers.
- Djourno A, Eyriès C. (1957). 'Prothèse auditive par excitation électrique à distance du nerf sensoriel à l'aide d'un bobinage inclus à demeure.' In: La Presse Médicale 65 no.63. 1957.
- Djourno A, Eyriès C, (1957) 'Vallencien B. De l'excitation électrique du nerf cochléaire chez l'homme, par induction à distance, à l'aide d'un micro-bobinage inclus à demeure.' CR de la société.de biologie. 423-4. March 9, 1957.
- Eisen MD (2003), 'Djourno, Eyries, and the first implanted electrical neural stimulator to restore hearing.' in: Otology and Neurotology. 2003 May;24(3):500-6.
- Grodin, M. (1997). Ethical Issues in Cochlear Implant Surgery: An Exploration into Disease, Disability, and the Best Interests of the Child. Kennedy Institute of Ethics Journal 7:231-251.
- Johnston, Trevor. (2004). W(h)ither the deaf Community? In 'American Annals of the deaf' (volume 148 no. 5),
- Kral A, Sharma A (2012), Developmental Neuroplasticity after Cochlear Implantation. Trends Neurosci 35(2): 111-122.
- Kral A, Eggermont JJ (2007): What's to lose and what's to learn: Development under auditory deprivation, cochlear implants and limits of cortical plasticity. Brain Res Rev 56: 259-269.
- Lane, H. and Bahan, B. (1998). Effects of Cochlear Implantation in Young Children: A Review and a Reply from a DEAF-WORLD Perspective. Otolaryngology: Head and Neck Surgery 119:297-308.
- Lane, Harlan (1993), Cochlear Implants:Their Cultural and Historical Meaning. In 'deaf History Unveiled', ed. J.Van Cleve, 272-291. Washington, D.C. Gallaudet University Press.
- Lane, Harlan (1994), The Cochlear Implant Controversy. World Federation of the deaf News 2 (3):22-28.
- Litovsky, Ruth Y., et al. (2006). "Bilateral Cochlear Implants in Children: Localization Acuity Measured with Minimum Audible Angle." Ear & Hearing, 2006; 27; 43-59.
- Miyamoto, R.T.,K.I.Kirk, S.L.Todd, A.M.Robbins, and M.J.Osberger. (1995). Speech Perception Skills of Children with Multichannel Cochlear Implants or Hearing Aids. Annals of Otology, Rhinology, and Laryngology 105 (Suppl.):334-337
- Officiers, P.E., et. a. (2005). "International Consensus on bilateral cochlear implants and bimodal stimulation." Acta Oto-Laryngologica, 2005; 125; 918-919.
- Osberger M.J. and Kessler, D. (1995). Issues in Protocol Design for Cochlear Implant Trials in Children: The Clarion Pediatric Study. Annals of Otology, Rhinology, and Laryngology 9 (Suppl.):337-339.
- Reefhuis J, et al. (2003) Risk of Bacterial Meningitis in Children with Cochlear Implants, USA 1997-2002. New England Journal of Medicine, 2003; 349:435-445.
- Spencer, Patricia Elizabeth and Marc Marschark. (2003). Cochlear Implants: Issues and Implications. In 'Oxford Handbook of deaf Studies, Language and Education', ed. Marc Marschark and Patricia Elizabeth Spencer, 434-450. Oxford: Oxford University Press, 2003.
- 3M Power Point Presentation on the Cochlear Implant.
- Barton G. Kids Hear Now Cochlear Implant Family Resource Center, University of Miami School of Medicine
External links[edit]
- What is it like to live with a cochlear implant? A short documentary video clip
- What do cochlear implants sound like? An audio example
- http://www.cochlear.com/
- [1] Understand how hearing works, how hearing loss can impact both adults and children and what steps are available for treatment.
- http://www.advancedbionics.com/
- Cochlear Implants Information from the National Institutes of Health (NIH).
- NASA Spinoff article on engineer Adam Kissiah's contribution to cochlear implants beginning in the 1970s.
- [*NPR Story about improvements to improve the processing of music. Includes simulations of what someone with implants might hear.
- Tuning In PBS article about advances in cochlear implant technology with simulations of what someone with each type of implant would hear.
- My Bionic Quest for Boléro (Wired, November 2005): Author Michael Chorost writes about his own implant and trying the latest software from researchers in a quest to hear music better.
- Charles Limb, "Building the musical muscle", TEDMED 2011, October 2011
- Richard Ladner, Commencement Address, Gallaudet University, Washington, DC, May 15, 2008.


text:
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675 Lancaster Ave., Frazer
Just have to say the staff at this Outback is sooo friendly and helpful. We go there for curbside take out at least once a week and always have HOT food and well prepared.
We do…
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134 E Gay St, West Chester

subset: commoncrawl


text:
Michael Gerson: Gays can keep their rights if they don't sue for them
In today's Washington Post, Michael Gerson compares and contrasts the debates over gay rights with the debate over abortion rights — and concludes that gay rights, once gained, will be longer-lasting and more "settled" because they (mostly) haven't been imposed by an out-of-control judiciary on an unwilling or divided public. Instead, the cause has advanced naturally and gradually through culture. And he warns:
Gerson might be right in a tactical sense. But his argument ignores a couple of things:
• The advancement of civil rights tends not to take an either-or approach to the question of judicial advances versus cultural advances. The ending of Jim Crow across the South, for example, clearly relied on court cases like Brown v. Board of Education, but the efforts of Martin Luther King Jr. and his cohorts simply made racism less acceptable as a matter of custom. Racism isn't gone, of course, but the days of being overtly racist and a participant in polite society are largely over. Both aspects — legal and cultural — were important to including African Americans in the life of the country.
• The argument also ignores the question of whether certain civil rights actually exist under the law. Pro-lifers and pro-choicers differ on this, of course, but if a right to abortion actually exists under the Constitution, then it doesn't really matter how "settled" the debate is. The whole point of being under the rule of law is to recognize that minority rights often conflict with the desires of the democratic majority.
It's nice if everybody likes it when you exercise your rights. But it's not strictly necessary.


text:
AUSTIN -- Thursday Governor Rick Perry signed what some call the "Merry Christmas" bill into law.
The governor says this was one way to end what he calls the "war on Christmas."
He says anyone can now say "Merry Christmas" or display religious symbols without fear of reprisal at Texas public schools.
When cheerleaders at Kountze High School put a Bible verse on one of their banners, it made national headlines.
"We were very surprised," said cheerleader Rebekah Richardson. "We'd never anticipated such a big controversy and chaos from it."
Thursday morning, the squad members and Central Texas Santas joined those cheering on Governor Rick Perry's signing of House Bill 308.
State Representative Duane Bohac sponsored the measure. His son Reagan was the inspiration.
"He told me that they decorated their 'holiday tree' with 'holiday' ornaments," Rep. Bohac said. "So I thought to myself, 'Why do we call it a 'holiday tree' at school and a 'Christmas tree' at home?'"
House Bill 308 allows public school students and staff to use traditional winter holiday greetings like Merry Christmas and Happy Hanukkah.
They can also display religious scenes and symbols like Christmas trees and nativities on school property.
"People of faith too often feel they can't express their faith publicly, and if they dare display it, they find themselves under attack from individuals and organizations that have nothing to do with them or their community for that matter," said Gov. Perry. "In no way does this advocate any particular religion over another. Instead, it insures freedom of expression where for many students teachers and administrators where it's most important."
Rabbi Zev Johnson says he's happy students can display menorahs and other items of faith without restraint.
"It just gives people, I think, that inspiration to take it a further step of being open and free and to have 'Happy Hanukkah' on people's lips. That's touching. It means a lot," the rabbi said.
Some Texans say it's interesting the governor is making a point about the freedom they already have.
"Where I don't know if it was necessary or not, I do think that it was very bold of him to do that," said Amanda Moore.
Ryan Sanders added, "It's freedom of speech. I mean, if you want to be religious you can be religious."
"We have a God, and he is with all of us at all times, and it's important for everybody to know that he is around," Devin Sanders said.
This bill doesn't change current law. It's just a way to make sure school districts and staff don't fear litigation.
The governor says by signing the bill he's standing up for religious freedom in the Lone Star State.


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Starting in February and going all the way through the end of September, it's the season for the major comic conventions. With events all over the country, it's hard to decide which ones are worth the trip.
Here are five of the biggest comic conventions in the U.S.
1. San Diego Comic-Con
Given that the San Diego Comic-Con is the biggest convention in the world, I would be extremely remiss if I didn't give this event a mention. San Diego is geek heaven for four days in July. It doesn't matter whether you prefer science fiction, horror, adventure, or animation – you'll find it all at this convention.
Not only is it the largest convention but it has also become THE place for Marvel and DC to unveil their latest projects, film and television previews and newest toys. 2007 saw 125,000 attendees come through the door.
2. Wizard World Chicago (formerly Chicago Comic-Con)
The Wizard World conventions are the second biggest conventions of their kind in the country, seeing attendance of over 58,000 people. At Wizard World Chicago, you'll find all the major players in the comic book industry, as well as artists, writers, and other celebrities.
Needless to say, there'll be plenty of vendors selling rare merchandise and lots of interesting people to watch. People new to the Wizard World Chicago convention will be surprised to find that the convention is not actually in Chicago proper, but in Rosemont, IL. You definitely want to book a decent hotel well in advance for this one.
3. Baltimore Comic-Con
Going into its tenth year next fall, Baltimore Comic-con is pretty much the last of the major Comic-Cons of the year. In comparison to some of the other major conventions, this one is low key and laid back.
This is a true convention for comic book fans. While other Comic-cons like San Diego have turned their focus to other forms of media and genres, Baltimore Comic-Con tends to focus strictly on the comic book industry. This convention also hosts The Harvey Awards, an award show for members of the comic book industry.
4. MegaCon
Along with WonderCon in San Francisco, MegaCon (in Orlando) kicks off the Comic-Con season. Around 20,000 comic book, science fiction, fantasy and anime fans converge on MegaCon each year.
One of the things most worth checking out at MegaCon is the Live Action Role Playing game, Paranoia Live! Based on a popular RPG game set in a dystopian future where a deranged computer protects an underground city, this LARP version is definitely worth seeing. Starting next year, MegaCon will also host the new annual Project Fanboy Awards.
5) Wizard World Los Angeles
Wizard World LA is much newer than the rest of the conventions on this list, getting ready to enter its sixth year. More laid back than its Chicago sister, it is considerably smaller than the media frenzy that is San Diego but it has potential for major growth.
Given its location at the Los Angeles Convention Center, its accessibility to Hollywood makes it definitely the convention to watch out for.
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Shiromi Arserio
Shiromi Arserio is British freelance writer currently making the Hawaiian Islands her home. She is webmistress of the science fiction news site http://www.igp-scifi.com. Along with being a self-proclaimed fan-girl, she loves to explore "new worlds", most recently the Great Barrier Reef.
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Great article. The idea of "fan tourism" sounds pretty fun, and it would be possible to see a great deal of the U.S. just by hitting these comic-cons. Maybe next year!
That wazs really informative, thanks San diego, gimme a couple of years and here i come! Great article, thanks again


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Lumley Insurance staff spent their Team Building afternoon completing a range of interesting activities to earn the pieces of a bike. The teams worked very hard but one team showed dominance all day.. It was the Awesome Orange Power Rangers that won the event. Well done everybody your efforts have made a large impact on […]


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|Release Date: April 13, 2007
|Running Time: 104 mins.
|MPAA Rating: PG 13
|Box Office: $80,050,171.00
|Genre: Thriller
• Check Out 'I Am Number 4' On Blu-ray, DVD, Download & On Demand May 24
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Carrie-Anne Moss
David Morse
Sarah Roemer
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Summary:Kale has a life most teenagers would envy. He spends his days endlessly playing video games, surfing the net, eating junk food and watching cable. He has complete free reign of the house, and a beautiful young hottie named Ashley has just moved in next door. There's only one problem--he's not allowed to leave the house. Kale's under court-ordered h... Full Summary >>
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Hot Topics: Catholic Church in Germany may OK morning-after pillGermany's Catholic Church may approve some so-called morning-after pills for rape victims after a leading cardinal unexpectedly announced they did not induce abortions and could be used in Catholic hospitals.
By: Reuters, INFORUM
Germany's Catholic Church may approve some so-called morning-after pills for rape victims after a leading cardinal unexpectedly announced they did not induce abortions and could be used in Catholic hospitals.
Cardinal Joachim Meisner of Cologne, an ally of German-born Pope Benedict, changed his policy after two Catholic hospitals refused to treat a rape victim because they could not prescribe the pill, which is taken after sex to avoid pregnancy.
The Catholic Church firmly opposes abortion and artificial birth control. Many Catholics see all emergency contraceptives as abortion-inducing drugs banned by this policy, but Meisner said some prevent fertilization and could be used in rape cases.
"The German Bishops' Conference is holding a regular meeting in two weeks, and the issue will certainly be on the agenda," Cologne archdiocese spokeswoman Nele Harbeke said Monday.
"The bishops' conference must in principle agree on a common line."
Meisner, 79, has in the past rejected emergency contraceptives as producing a "just-in-case abortion."
The pills have become a hot issue in the United States as many Catholics oppose President Barack Obama's health reform in part because it mandates Catholic hospitals to provide birth control for female employees.
One pill, marketed as "Plan B" in the United States and based on the synthetic hormone levonorgestrel, is rejected by these critics as an abortifacient but might meet Meisner's criteria.
The Cologne incident sparked uproar in Germany last month, and the cardinal apologized publicly, saying it "shames us deeply because it contradicts our Christian mission and our purpose".
The German Catholic Hospitals' Association hailed Meisner's statement for spelling out what they can do for rape victims.
"We are still against the abortion pill," association official Thomas Vortkamp told Cologne's Catholic broadcaster Domradio. "But it helps to know we can give a 'morning-after pill' in cases of raped women who must be helped urgently."
Tags: religion, health, shesays


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"Customer service is priority #1 at Rocky Mountain ATV/MC. We value our customers and strive to be the best shopping experience- when you buy from us, you are buying lifetime service."
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We take pride in offering no hassle returns. In the event of a return, please call, email or chat with us to receive a solution to the problem. For apparel that doesn't fit quite right, Click here to see our Fit Guaranteed Program.
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Comments On Mar 28, 2014:works great! easy to install
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Comments On Sep 03, 2013:This was 1/2 the price of other brands to do the same job. Why pay more? Works great. Another great product from TUSK. Put 600 HARD miles on my KTM 450XC and it is still working great.
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Comments On Aug 28, 2013:I used this switch on two of my bikes, and one on a friends bike. All 3 failed.
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Comments On Jun 10, 2013:I did eventually get it to work but the aluminum (?) crush washers that came with it were very stiff. I'm used to copper crush washers and it seemed like I needed an excessive amount of torque to get it to seal but I finally got it to stop leaking. 600 miles later it is still dry and I have brake lights on my KTM.
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Comments On Mar 27, 2013:Worked great
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Comments On Apr 10, 2012:this fit great and worked great on my ktm. cant beat the price
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Comments On Mar 26, 2012:This is essentially the same switch sold under other manufacturers only for less $. Good quality for an overseas part.
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Comments On Feb 05, 2012:I installed in combination with Polisport LED taillight. Wires nice and long. NOT a direct OEM connection to KTM/Husaberg wirng harness. I crimped on matching bullet connectors, for clean install. No wiring instruction included, so you'll need from shop manual. Saved lots of money over OEM parts.
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Comments On Apr 28, 2011:I have run this for 8 months so far. It works great. it was the easiest way to get a brake light on my ktm so i could make it street legal.
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Comments On Mar 09, 2011:excellent price but not as durable as others
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High winds mean lots of work for repair crews
Downed trees, missing shingles a common problem
Monday's high winds caused quite a bit of damage throughout San Antonio, which created more business for repair crews and roofing companies.
"We're getting an overwhelming amount of calls," said Ronnie Suarez, owner of Integrity Roofing Windows & Siding. "In fact, we've gotten 50-plus calls above our normal amount of calls that come in."
The most common problem, Suarez says, is shingles missing from rooftops.
"A lot of them are saying that they opened the door this morning and they've got shingles everywhere," he said. "Shingles in their driveway, shingles all along their lawn."
It's a problem Johnson Oshana is now familiar with.
The wind ripped dozens of shingles off of his home on Pasadena Street, tossing many of them into his driveway on the opposite side of the house.
"Even some chairs outside, they flew to the other side," Oshana said. "It was really scary. I was thinking the big trees back there were going to fall on our house, on top of our house."
Meanwhile, Monday's wind flattened part of a home that was under construction on Stately Oaks on the far north side of San Antonio.
Crews with the city of San Antonio Public Works Department also spent part of Tuesday estimating damage and making any repairs needed to street lights or removing debris from public areas.
Copyright 2013 by KSAT.com All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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Garage Shots
We called out for you to send us your Jeep projects that you've built in your garage, and you responded in a big way. Originally we thought that this story would be about complete frame-off kind of restifications. But along the way we received a lot of partial rebuilds, engine rebuilds, Jeep repowers, and so forth. We always enjoy learning about your ideas, and for this story it's no different. This story is influenced by you—the pictures are your pictures and the words are yours as well. Except for the stuff we made up, of course.
Unfortunately, as so often happens, the submissions that had the best pictures had the least information. They say a picture is worth a thousand words, and even if it isn't, we couldn't bring ourselves to run postage-stamp-sized pictures that were often blurry. So we picked the best images we had and filled in what holes we could. That didn't always pan out, so enjoy the modified Hard Facts section too. If we didn't get the info, we guessed or just made stuff up that we thought was funny.
Gas shortages, taxes, and less power output due to smog equipment signaled the sunset of the muscle car horsepower wars. All the U.S. automakers were looking for ways to boost the perceived performance of their offerings. Like some of its contemporaries, Jeep teamed up with Hurst Performance Products to create the Hurst Jeepster. It was equipped with a Dauntless V-6 engine coupled to a TH400 automatic transmission. There were a lot of Hurst-only parts that made them unique. Things like the Hurst emblems, special stripes, hood-mounted tach, hoodscoop, and aluminum slot wheels are but a few of them. There were only about 100 Hurst-edition Jeepsters made, making them exceedingly rare today.
Russell Witkop has been a Jeepster enthusiast for quite a while. When the time came for him to own his own Hurst-edition Jeepster, he wasn't about to pay the exorbitant prices that they sometimes fetch. Besides, all the custom stuff is normally missing or needs to be redone anyway. Rather, Russell picked up a complete basket-case '71 that originally had A/C, power steering, and power brakes and set about bringing it back to life. Maybe he found the Jeep, maybe the Jeep found him; who's to say? What we do know is that he did a heck of a job re-creating a Hurst Jeepster, and thanks to his efforts there are now stripe kits available for those of us who want to make our own Hurst replicas.
PhotosView Photo Gallery
Hard Facts (as far as we can guess)
Vehicle: '71 Hurst Jeepster Commando
Engine: 225ci Dauntless V-6
Transmission: TH400
Transfer Case: Dana 20
Suspension: Stock spring-under (front and rear)
Axles: Dana 27 (front); Dana 44 (rear)
Wheels: 15x7 factory slot wheel
Tires: Sporting a lot of Armor-All in that "after" shot
MB Cancer Cure
Craig Groeger of Ridgeway, Pennsylvania, sent in his amazing rescue of an old (we assume) MB. From the pictures we saw, we think he reskinned the entire exterior of the Jeep. And, having some experience with northeast rust, he probably did a fair amount of work on the interior of it as well.
Pete Trasborg met him out at the Butler, Pennsylvania, Bantam Festival, and Craig had just painted the Jeep—as in it was painted the Saturday before the show. Naturally, the paint was still pristine when Pete saw it, but we are sure that by now it has at least a bit of custom pinstriping.
PhotosView Photo Gallery
Hard Facts (as far as we suppose)
Vehicle: Willys MB
Engine: Yep, there is one under that hood
Transmission: Manual (as it should be)
Transfer Case: Got one of them, too
Suspension: Spring-under with heavy-duty aftermarket shackles (front and rear)
Axles: Unknown, but the rear one has discs and what appear to be cast GM-style U-bolt plates
Wheels: Old-school Jackman with custom beadlock
Tires: Interco Irok


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York Beach Cinema
6 Beach Street,
York Beach,
No one has favorited this theater yet
The York Beach Cinema closed after Labor Day 2006 and was demolished at the end of October 2006.
Recent comments (view all 10 comments)
Can you say more?
This article dated January 18, 2006 talks about a proposal to raze the Beach Cinema. In case the link expires, here is the text:
Proposal to raze beach cinema moves ahead
By Jennifer L. Saunders
"YORK BEACH – The days of York Beach Cinema will soon be coming to an end.
At its meeting Thursday night, the Planning Board granted preliminary approval to an application to raze the theater building and construct a function hall for the nearby Union Bluff.
The property, which is located at 4 and 6 Beach St. and abuts Gull Street, is owned by the Ogunquit Beach Club.
The Planning Board's vote came after a public hearing where residents from Gull Street spoke in favor of the project.
Bill Roche said that he and his neighbors use their seasonal residences about six months out of every year.
"As direct abutters of this theater project, this has a direct impact on our quality of life," he said.
After meeting with Brent Merritt of the Union Bluff on their concerns, Roche said he and his neighbors felt he addressed all their concerns regarding such issues as sound buffering, landscaping and traffic.
The residents are seeking to close off access to Gull Street, except for emergency vehicles.
"Brent Merritt doesn't have any problem with that concept and is going to be working with us," Roche said. " … Working with Brent Merritt has been a pleasure. He has been a good commercial neighbor."
Fellow property owner Michael Passanisi echoed Roche's comments.
"My wife and I fully support his project," he said, describing Merritt as proactive and easy to work with toward the solutions.
Another seasonal resident, Walter Cashman, added he also fully supports the project.
The project will be at the same height of the current cinema building, and will include trolley service to and from functions to alleviate parking concerns.
Planning Board Vice Chairman Glen MacWilliams applauded the applicant for addressing the constant issue of parking lacking in the beach.
Planning Board member Tom Manzi said that while there is a net gain in the area in terms of parking, there is also a "net loss" in terms of the loss of public entertainment opportunities provided by the theater.
"This is not going to be a dinner theater substitute … it's going to be private. The public entertainment potential is diminished on one hand, while we get more parking," Manzi said. " … It's a bittersweet realization of the changing nature of the beach. … If that is a trend, it changes the social welfare and the uses of the beach."
The board voted unanimously to approve the preliminary plan and will schedule the item for final review at a future meeting.
The Planning Board's other business included:
A continued discussion of the application for Bayberry Ridge Elderly Congregate Housing, a proposed 17-unit elderly congregate housing subdivision with a community center.
A public hearing on proposed amendments to the board's site plan and subdivision regulations and requirements for professional certification and inspections, driveway construction in subdivisions, timeframe for construction and impact statement requirement.
Another public hearing will be held on those items at 7 p.m. on Thursday, Jan. 26, at the York Public Library".
According to This article dated August 02, 2006, the York Beach Cinema will close after Labor Day weekend.
we need pics………….
Here is a very small photo of this theater and this website has another. Anyone that lives or vacations in the area should see a movie here before it closes. And bring along a camera.
looks like a neat theater
Take note New England, another piece of your history just went away. Sad that this had to happen. As an owner in the shallower pool of independent cinemas I know what a loss this is to everyone involved. The staff of the IOKA salutes all of you that worked so hard to support this cinema over the years. You will be missed.
Here is a photo of the demolition:
Here is a photo taken about a month before the cinema was demolished.
Here is a 1987 photo:
Just login to your account and subscribe to this theater


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WoW! AthHalf Training
AthHalf: Half Marathon in Athens, GA
October 20, 2013
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Sea lion snatches catch from fisherman (Video)
Sea lions have been known to exhibit aggressive behavior. They can bark loudly and demand food from passersby.
Halloween candy calorie count: How long you'll have to walk per treat
Like kids, parents are tempted to dig-in, but even those small "fun-sized" candy bars can do damage to the waistline.
Iowa college says squirrel vandalized bicycle
Squirrel suspected of being culprit in vandalized bicycle incident at Iowa community college
Ways to protect your car from Halloween vandalism
You might be too old for trick-or-treating, but look out: This Thursday night, someone could target your sweet ride.
Scientists dig for fossils in LA a century later
Surrounded by a gooey graveyard of prehistoric beasts, a small crew diligently wades through a backlog of fossil finds from a century of excavation at the La Brea Tar Pits in the heart of Los Angeles.
Paranormal poll: Americans believe in, aren't scared of, ghosts
Sorry, Ghostbusters. A new paranormal poll finds that most Americans aren't afraid ghosts - even though they believe in them.
Sand needed in Calif. city due to eroding beaches
Got sand? Some are sending it to Port Hueneme, Calif., where eroding beach is a problem
Austrian woman offers live tank shell on swap site
Dummy tank shell offered on Austrian swap site revealed as live explosive
Ind. woman who donated kidney weds organ recipient
Indiana woman who donated kidney to ailing man weds him 3 years after transplant surgery
Authorities capture mysterious goat in Des Moines
Animal control officers capture mysterious goat on the run for hours in Des Moines
Man owns $10 silver certificate valued at $500,000
Suburban Philly man owns 1933 $10 silver certificate valued at half-million dollars
UK town Stilton told it can't make stilton cheese
English village of Stilton stymied in bid to make namesake cheese
What would you name a baby born on the Beltway?
So what do you name a baby boy when he is born on the Capital Beltway? A few suggestions.
Dramatic kitten rescue caught on video
What do you get when you combine a GoPro camera, a firefighter and an injured kitten?
Calif. race complaints get directed to sex line
Callers complaining about Nike marathon in San Francisco mistakenly directed to phone sex line
The toll alcohol takes on your skin
Those drinks you had last night might be all over your face the next morning.
Arizona city OKs ice cream truck after long freeze
16-year-old girl scoops up Scottsdale, Ariz.'s 1st ice cream truck license after long freeze
Hawaii surfer throws punches to escape shark
Hawaii surfer escapes shark attack by throwing punches, jamming a knuckle in fish's eye
Groom who halted own wedding with bomb hoax jailed
British bridegroom who used bomb hoax to cover wedding day bungle sent to jail
Runner in KC Marathon sets knitting record
Runner in Kansas City Marathon knits record-setting scarf more than 12 feet long
Hi: 62 °F | Lo: 38 °F


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Use our interactive maps to learn about international migration, including immigrant and emigrant populations by country and trends in global migration since 1960. One of these maps was referred to by a news organization as "addictive" and "a font of fun facts."
Visit Page
Remittances are among the most tangible links between migration and development. According to World Bank projections, international migrants are expected to remit more than $550 billion in earnings in 2013, of which $414 billion will flow to developing countries. In 24 countries, remittances were equal to more than 10 percent of gross domestic product (GDP) in 2011; in nine countries they were equal to more than 20 percent of GDP.
View the Guide
State Data Profiles
These interactive charts visualize changing immigration patterns and characteristics of the immigrant population in the United States over time. Topics covered include: Legal Immigration Flows, Naturalization Trends, Immigrants' Countries and Regions of Birth; Diaspora Groups in the United States; Children in Immigrant Families; Immigrants in the U.S. Labor Force; Limited English Proficient (LEP) Population; and Age and Gender Distribution of Immigrants.
International Migration Statistics data charts and files from MPI's Data Hub.
Click on the title above to go to the maps page, or select the map of interest below: